Overview of CPT Code 21195: Injection of bone cement into the vertebral body

Overview of CPT Code 21195: Injection of bone cement into the vertebral body

CPT Code 21195 refers to the procedure of injecting bone cement into the vertebral body, primarily used to treat vertebral compression fractures.

When CPT Code 21195 is Used?

This procedure is indicated in specific clinical scenarios.

• Vertebral compression fractures due to osteoporosis.
• Pathological fractures from tumors or malignancies.
• Pain management in patients with vertebral fractures not responding to conservative treatment.

Symptoms Indicating This Procedure

Patients may report various symptoms that lead to this procedure.

• Severe back pain localized to the fracture site.
• Limited mobility or difficulty in performing daily activities.
• Neurological symptoms such as numbness or weakness in the legs.

Causes and Risk Factors

Understanding the causes and risk factors can help in prevention.

• Osteoporosis leading to weakened bones.
• Age-related bone density loss.
• Previous history of fractures.
• Certain medications that affect bone health.

Diagnostic Tests Before Procedure

Several diagnostic tests are performed to confirm the need for this procedure.

• X-rays to visualize the fracture.
• MRI to assess the extent of the fracture and surrounding tissues.
• CT scans for detailed imaging of the vertebrae.

Procedure Description

The procedure involves several key steps.

• Patient is positioned comfortably, usually lying on their stomach.
• Local anesthesia is administered to numb the area.
• A needle is inserted into the vertebral body under fluoroscopic guidance.
• Bone cement is injected into the vertebra to stabilize the fracture.
• The needle is removed, and the site is bandaged.

Preparation for the Procedure

Patients should follow specific guidelines before the procedure.

• Discuss any medications with the healthcare provider.
• Avoid blood thinners for a specified period before the procedure.
• Arrive at the facility with a responsible adult for post-procedure transport.

Recovery and Aftercare

Post-procedure care is crucial for recovery.

• Rest for the first 24 hours post-procedure.
• Gradually resume normal activities as tolerated.
• Follow-up appointments to monitor healing and pain levels.

Possible Complications

While generally safe, there are potential risks involved.

• Infection at the injection site.
• Allergic reaction to the bone cement.
• Increased pain or new fractures.

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Post-Procedure Follow-Up

Regular follow-up is essential for monitoring recovery.

• Initial follow-up within one week to assess pain and mobility.
• Subsequent visits at one month and three months post-procedure.
• Imaging studies may be repeated to evaluate healing.

Alternative Treatments

There are non-surgical options available for managing vertebral fractures.

• Physical therapy to strengthen back muscles.
• Pain management with medications.
• Bracing to support the spine.

Home Care Tips

Patients can take steps at home to aid recovery.

• Use ice packs to reduce swelling and pain.
• Engage in gentle stretching and strengthening exercises as advised.
• Maintain a healthy diet rich in calcium and vitamin D.

Patient Education & Prevention

Education is key to preventing future fractures.

• Regular bone density screenings for at-risk individuals.
• Lifestyle modifications including weight-bearing exercises.
• Avoiding smoking and excessive alcohol consumption.

Billing and Coding Information

CPT Code: 21195

Category: Surgical Procedures

Common Modifiers:

• -50
• -LT
• -RT

Average Cost and Insurance Coverage

Costs can vary based on location and insurance.

• Average cost ranges from $5,000 to $15,000.
• Most insurance plans cover the procedure if medically necessary.
• Out-of-pocket costs depend on the patient's insurance plan.

Related CPT Codes

• 20610 - 'Arthrocentesis, aspiration of joint'
• 20605 - 'Arthrocentesis, aspiration, and/or injection into a major joint or bursa'

References and Sources

• Vertebroplasty and Kyphoplasty
• Management of Osteoporotic Vertebral Fractures